Shared Decision Making for Older Adults: Time to Move Beyond Dialysis as a Default
Authors: Fahad Saeed, Jane O. Schell
Journal: Annals of Internal Medicine (2022)

EditorialsJanuary 2023Shared Decision Making for Older Adults: Time to Move Beyond Dialysis as a DefaultFahad Saeed, MD, Jane O. Schell, MDFahad Saeed, MDDivisions of Nephrology and Palliative Care, Departments of Medicine and Public Health, University of Rochester Medical Center, Rochester, New York, Jane O. Schell, MDRenal-Electrolyte Division, and Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3431 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For older adults facing kidney therapy decisions, more dialysis is not always better. Currently, dialysis is often the default option, even for older patients with end-stage kidney disease (1). Yet, older people with several comorbidities tend to incur substantial burdens due to dialysis, including loss of independence and increased hospitalizations, at times without a significant survival benefit. Data suggest that many people make life-altering decisions for dialysis without receiving full information about their choices or discussing their prognosis (2). Alternative treatment options exist for individuals with kidney disease, especially for those who are likely to incur more burdens than benefits ...References1. Wong SP, Hebert PL, Laundry RJ, et al. Decisions about renal replacement therapy in patients with advanced kidney disease in the US Department of Veterans Affairs, 2000-2011. Clin J Am Soc Nephrol. 2016;11:1825-33. [PMID: 27660306] doi:10.2215/CJN.03760416 CrossrefMedlineGoogle Scholar2. Saeed F, Sardar MA, Davison SN, et al. Patients' perspectives on dialysis decision-making and end-of-life care. Clin Nephrol. 2019;91:294-300. 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[PMID: 24624995] doi:10.1186/1472-6947-13-S2-S11 CrossrefMedlineGoogle Scholar7. Schell JO, Cohen RA, Green JA, et al. NephroTalk: evaluation of a palliative care communication curriculum for nephrology fellows. J Pain Symptom Manage. 2018;56:767-73.e2. [PMID: 30118758] doi:10.1016/j.jpainsymman.2018.08.002 CrossrefMedlineGoogle Scholar8. Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179:1688-97. [PMID: 31589281] doi:10.1001/jamainternmed.2019.4235 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Fahad Saeed, MD; Jane O. Schell, MDAffiliations: Divisions of Nephrology and Palliative Care, Departments of Medicine and Public Health, University of Rochester Medical Center, Rochester, New YorkRenal-Electrolyte Division, and Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3431.Corresponding Author: Fahad Saeed, MD, Divisions of Nephrology and Palliative Care, Departments of Medicine and Public Health, University of Rochester Medical Center, Rochester, NY 14642; e-mail, [email protected].rochester.edu.This article was published at Annals.org on 20 December 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffectiveness of an Intervention to Improve Decision Making for Older Patients With Advanced Chronic Kidney Disease Keren Ladin , Hocine Tighiouart , Olivia Bronzi , Susan Koch-Weser , John B. Wong , Sarah Levine , Arushi Agarwal , Lucy Ren , Jack Degnan , Lexi N. Sewall , Brianna Kuramitsu , Patrick Fox , Elisa J. Gordon , Tamara Isakova , Dena Rifkin , Ana Rossi , and Daniel E. Weiner Metrics January 2023Volume 176, Issue 1Page: 129-130KeywordsChronic kidney diseaseCommunication in health careDecision makingElderlyNephrologyRenal failure ePublished: 20 December 2022 Issue Published: January 2023 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...